Thursday, 16 June 2016

There’s a lot of advice about how to give up smoking but, as with many public health initiatives, much of it is one-size-fits-all and so not very helpful to anyone who isn’t a mythical average.

This is my experience after 23 days of not smoking. None of what follows is setting myself up to fail, it’s being realistic about the task ahead and preparing myself for it. As the Boy Scouts say: Be Prepared. As far as I can see, thinking it will be easy is the best way to fail. Forewarned is forearmed.

What they don’t tell you
It will be fucking awful. No one tells you quite how awful it will be because all the health advice givers want you to stop.

Mood swings. I expected to be a bit grumpy. I didn’t expect to want to punch people, to burst into tears and to be bouncing around like Tigger all in the same day. Things and people that would normally mildly irritate you will make you go postal. It’s a bit like the worst PMS - for weeks on end.

If you live in a city and/or use public transport getting your sense of smell back is not a bonus. London and Londoners do not smell good.

You may never stop wanting to smoke. People have told me that even 30 years on they would go back to it if it was safe.

Cravings feel like a monster has taken over your body. Advice says that they get weaker and less frequent after about 14 days. They should last just a few minutes and then pass. Not so far. I still want to smoke just as much and just as often. My cravings can last up to half an hour.

Most people fail. Some research shows that around a third of smokers try to quit each year and that ‘fewer than one in eight former smokers who had abstained for a month or less at baseline were continuously abstinent over the next 2 years’. Other research has varying percentages for cold turkey and assisted quitting but in all cases, the percentage who succeed is very small.

What not to say
Do not say ‘I decided to give up and just did it. It was easy’. I will slap you. Hard.

Do not say ‘It doesn’t matter if you put on a bit of weight’. It clearly does matter or it wouldn’t have been mentioned. Stick to making sympathetic noises.

Do not say ‘Think of all the money you’re saving’. If that was a reason for giving up, no one would smoke. See also comments about not smelling like an ash-tray, not dying etc etc. I gave up because I just wasn’t enjoying it any more. I didn’t want to smoke. As simple as that. This doesn’t mean I don’t want a cigarette. Because I’m an addict.

ETA: Do not say 'Try to avoid triggers'. For me these are: waking up, going to the gym, eating, drinking and, it turns out, being with one of my closest friends (a non-smoker).

Do not talk about being a chocoholic or being really grumpy before you have your morning coffee. If you haven’t been a smoker, you won’t get it.

This may sound harsh and ungrateful but I reserve the right to be Oscar the Grouch verging on She Hulk for the next few months.

Nicotine Replacement Therapy
NRT covers products like patches, nicotine gum, inhalators and e-cigarettes. In theory it helps break the habit of smoking (as opposed to the addiction) while still getting some nicotine to lessen the cravings, and it doubles the chances of success.

The problem is that it’s aimed at a theoretical average smoker of 20 full-strength cigarettes a day who would get about 15mg of nicotine. I was smoking 10-12 of what used to be called ultra-low cigarettes which meant that I was getting about 1mg of nicotine a day. So I would have to use about 6% of a nicotine patch – not exactly practical. There are products with less nicotine for phased quitting but even these would give me a lot more than I was previously getting.

You’d think this would mean quitting was easier, but no. I know this because I tried to give up about 20 years ago when I was smoking 20 full-strength a day.

I opted for an inhalator and worked out from the information given that about 15 seconds of sucking on it would give me about the same nicotine as a cigarette. But there is no precise information about how nicotine absorption from cessation products compares with smoking other than the fact that it’s slower and less effective. Advice tells you to suck until you feel satisfied but as it takes longer to feel the effect you can end up getting a lot more nicotine than you actually want or need. So I’m very probably getting more than I was - although in a safer form.ETA Day 32: I've done a bit more research and concluded that I was possibly under-dosing with the inhalator, which is why the first few weeks were so rough. I wasn't quite going cold turkey but certainly lukewarm turkey.

Some people I know used vaping and e-cigs as a way to give up and it worked for them. But if you go into vaping shops and talk to staff (as I did), it’s clear that vaping is becoming a hobby in itself with accessories, flavourings and associated products. I did consider it but I didn’t want to look like Puff the Magic Dragon billowing out clouds of vapour. Most of the flavourings smell disgusting to me. Many places don’t allow it indoors now so I’d have to go outside to do it and I want to break that association. It’s a lot more involved than lighting a cigarette (flavoured liquids, replacing coils at regular intervals, charging batteries and so on) and I just wanted to get the nicotine into me in the simplest and least twattish way.

Weight gain
This is a big one for me. When I gave up about 20 years ago I put on about 30lbs/13.5kg. I couldn’t lose it after a year and got so miserable that I went back to smoking. At the moment, my weight is about 4.5lb/2kg above where it should be and it’s a battle royal to stop it going any higher. Nicotine is an appetite suppressant and metabolism stimulant, which is why you gain weight when you stop smoking. If you’re using NRT this shouldn’t happen. But it has.

Your digestion will get messed up and your metabolism may well slow down so even if you resist the urge to snack you’ll gain weight. It also kicked off my Irritable Bowel Syndrome. Oh joy.

The advice web sites say to exercise more. I already go to the gym four times a week and walk a lot. I’m trying to walk more but it’s killing my knees. Being atypical sucks.

Getting help
One big difference between giving up now and my failed attempt 20+ years ago is social media. It didn’t exist then. Telling everyone on Twitter and Facebook that I’d given up meant that backing down was a lot harder but, more importantly for me, it means that I can get support and encouragement, especially if I'm having a bad day.

The downside is that giving up takes months and months and people will lose interest in daily updates. I don’t blame them, I would too. So I’ve picked a couple of close friends for long-term support, people who won’t get sympathy fatigue. Lucky them.

The next step
The advice is to use NRT for at least 12 weeks as in theory this is how long it takes to break the habit or at least the psychological addiction. Again, this is a one-size-fits-all guestimate. Some people take a lot longer. I’m not expecting to get over 30 years of smoking in a couple of months. And I am not a patient person. This is the long, slow, tedious bloody haul.

Nicotine itself isn’t that bad for you so getting off the NRT isn’t such a pressure. It’s generally considered no worse than caffeine – not totally without negative effects but way safer than smoking. So I may still be using it this time next year. We’ll see.

I haven’t fallen off the wagon yet. The important thing is to take responsibility for quitting. I’ve decided that if I do have a smoke, I won’t blame anyone or anything else. I am not a victim, I have had a lapse of willpower. It happens. Get back on the wagon.

After smoking for so long I accept that there may be some damage that will never be reversed.

Someone asked me if I now see myself as a non-smoker. I see myself as someone who is not smoking right now. That’s not giving myself an escape route, that’s focussing on the present because it’s in the present that I want to smoke.

About Me

Hello, gentle reader.
I write mostly about skeptical and (roughly) scientific matters, often health, gender and sex related.
I run London Skeptics in the Pub and I have a PhD in something you will never need to know about.
twitter @tessakendall